Vernix and Amniotic Fluid

Why not to wash your new baby straight away... Why to avoid artificial rupture of your membrances... It turns out that vernix (the white stuff some babies are born with) and amniotic fluid have similar immune enhancing properties to breast milk... artificial rupturing of membranes can take away the amniotic fluid's protective capability. Cleaning your baby straight away can take away the immune protecting properties of vernix....

Source: Pubmed central. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1595247 ANTIMICROBIAL PROPERTIES OF AMNIOTIC FLUID AND VERNIX CASEOSA ARE SIMILAR TO THOSE FOUND IN BREAST MILK Akinbi, H. T., Narendran, V., Pass, A. K., Markart, P., & Hoath, S. B. (2004). Host defense proteins in vernix caseosa and amniotic fluid. American Journal of Obstetrics and Gynecology, 191(6), 2090–2096. Summary In this study, researchers analyzed samples of amniotic fluid and vernix caseosa (vernix) from healthy, term gestations to determine the immune properties of these substances. Participants were pregnant women admitted for elective cesarean section after 37 weeks gestation with no prior labor and no signs of chorioamnionitis (intrauterine infection). Women with a history of prenatal fever or premature rupture of membranes, or who received steroids prenatally or antibiotics while giving birth were excluded, as were women whose babies passed meconium in utero, had congenital malformations, or required prolonged resuscitation after birth. Amniotic fluid was obtained by amniocentesis to determine fetal lung maturity prior to elective birth. Vernix was gently scraped from the newborn's skin with a sterile implement immediately following birth. The researchers obtained 10 samples of amniotic fluid and 25 samples of vernix. Tests (Western analysis and immunochemistry) revealed that lysozyme, lactoferrin, human neutrophil peptides 1–3, and secretory leukocyte protease inhibitor were present in the amniotic fluid samples and in organized granules embedded in the vernix samples. These immune substances were tested using antimicrobial growth inhibition assays and found to be effective in inhibiting the growth of common perinatal pathogens, including group B. Streptococcus, K. pneumoniae, L. monocytogenes, C. albicans, and E. coli. The authors point out that the innate immune proteins found in vernix and amniotic fluid are similar to those found in breast milk. As the baby prepares for extrauterine life, pulmonary surfactant (a substance produced by the maturing fetal lungs) increases in the amniotic fluid, resulting in the detachment of vernix from the skin. The vernix mixes with the amniotic fluid and is swallowed by the growing fetus. Given the antimicrobial properties of this mixture, the authors conclude that there is “considerable functional and structural synergism between the prenatal biology of vernix caseosa and the postnatal biology of breast milk” (p. 2095). They also suggest that better understanding of these innate host defenses may prove useful in preventing and treating intrauterine infection. Significance for Normal Birth Routine artificial rupture of membranes increases the likelihood of intrauterine infection because it eliminates the physical barrier (the amniotic sac) between the baby and the mother's vaginal flora. This study suggests an additional mechanism for the prevention of infection when the membranes remain intact: A baby bathed in amniotic fluid benefits from antimicrobial proteins that are found in the fluid and in vernix caseosa. The results of this study also call into question the routine use of some newborn procedures. Early bathing of the baby removes vernix, which contains antimicrobial proteins that are active against group B. streptococcus and E. coli. Delaying the bath and keeping the newborn together with his or her mother until breastfeeding is established may prevent some cases of devastating infections caused by these bacteria. The fact that preterm babies tend to have more vernix than babies born at or after 40 weeks might mean that healthy, stable preterm babies derive even greater benefit from staying with their mothers during the immediate newborn period. Finally, this study illustrates how the normal physiology of pregnancy and fetal development is part of a continuum that extends beyond birth to the newborn period. The immunologic similarities between amniotic fluid, vernix, and breast milk provide further evidence that successful initiation of breastfeeding is a critical part of the process of normal birth

Epidurals

By Sarah Vine

When offering a woman an epidural at childbirth, in my experience, midwives and anesthesiologists rarely explain all the side effects that accompany this form of pain relief. I feel this is very wrong, if women are purported to have ‘free choice’ for childbirth! That is why I am including this information on epidurals.

The main reason I try to avoid epidurals because of the increase likely hood of other interventions that may follow: epidurals commonly cause blood pressure to go down, so a saline IV is introduced. Another side effect is that contractions may then tail off, so pitocin (a synthetic hormone that stimulates contractions) is added. Contractions suddenly get very strong with pitocin use, which may cause the baby’s heart rate to drop…. etc. I have met midwives who believe that the epidural can help a woman who is fighting contractions relax, and allow the dilation to take place, and in some cases this might be true. In preparation to allow this to happen without resorting to drugs, you can practice pregnancy yoga, and/or look into hypnobirthing techniques to help yourself relax and let go.

Epidurals also stop the release of oxytocin by your brain – oxytocin is the body’s natural pain relief. (I wish it were stronger too!) As pain increases, oxytocin levels increase too. As soon as pain goes up a notch, you may start to panic that you can’t cope, but if you can mentally get on top of the panic, you may find yourself coping better again in a few minutes as the oxytocin levels increase in response. It is also an important hormone for bonding with the baby, and for breastfeeding. It doesn’t mean you can’t bond or breastfeed after an epidural birth, but the intuitive response, from my experience, sometimes seems lower. I have had both kinds of births, and the cocktail of hormones and joy make one so high for weeks after a natural birth, as opposed to a birth with lots of interventions which leaves you feeling like a train has run over you, and instead of positive hormones your body has drugs to flush out.

It is rare, but things do go wrong with epidurals. The placement of the IV is in the space just before entering the dura, the which protects the center of your spine where spinal fluid flows up to the brain. If the placement is wrong and the dura is punctured, spinal fluid leaks out and the result is an excruciating headache that may last for days or even weeks – severely interrupting the crucial period for bonding and learning breastfeeding techniques. (Dura puncture rate between 1 and 5 cases out of 100. See below for source.) Another rare occurrence is when the epidural is only partially effective, meaning one half of the body is pain free while the other half feels everything. Sometimes it’s only a small patch of stomach that can still feel pain – but unfortunately, since the oxytocin (natural pain reliever) in the brain has been switched off, the pain in that one spot is even MORE excruciating than before, which can be very distressing for the mother, especially since she has been looking forward to being pain free. The NHS suggests that 1 of 6 epidurals is unsatisfactory.

Now, if you do decide to have an epidural, you can rest assured that you know all the side effects and that you are going into this with eyes wide open. Whatever you do, do NOT feel guilty or like a failure. Every woman’s pain is different, and modern medicine does have huge benefits when properly used. You have a free choice, you do not need anyone’s permission or approval here.If an epidural is what you need to give birth without fear, and welcome your child with joy, then take it. It is important not to bear guilt afterwards.

The ultimate goal is to be able to give birth in full knowledge of the miracle, the holy moment when the breath of life enters your child’s body and you gaze at each other, eye to eye. Embrace the experience!

Management of Accidental Dural Puncture and Subsequent Headache
By Stephanie Goodman, M .D. , Associate Clinical Professor of Anesthesiology, Department of
Anesthesia, Colum bia Presbyterian Medical Center, New York, New York

Epidural analgesia in labour St Mary’s NHS Trust